Provider Demographics
NPI:1558772186
Name:MIRMANESH, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:MIRMANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2053
Mailing Address - Country:US
Mailing Address - Phone:727-610-5335
Mailing Address - Fax:727-610-5335
Practice Address - Street 1:6650 78TH AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2053
Practice Address - Country:US
Practice Address - Phone:727-610-5335
Practice Address - Fax:727-610-5335
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10070800208200000X
CA141171208200000X
PAMD466542208200000X
DEC1-0013021208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery